Casual for Kidney Day Registration Form

Company/School:

Address:

City:

State:

Zip:

Contact Person (Captain):

Title:

Daytime Phone:

E-mail Address:

Number of Buttons:*

Number of Employees:

Number of Posters:

Our company is a "Matching Gift Company" and will match what our employees collect.

We would also like to receive information about the free KEEP Healthy kidney health checks for our employees.

Our school would be interested in a classroom or school assembly about organ donation.

     

* buttons are provided on consignment. Unused buttons can be returned.